The Radical Doula: An Interview With Miriam Zoila Pérez
Speaking out against inequality in maternal care.
Miriam Zoila Pérez stepped onto the TED stage last year with a very blunt message: racism harms pregnant women. Miriam described how far too many women in our country do not have the luxury, let alone courtesy, to choose their own path through pregnancy and birth; how simple solutions and shifts in the mindset and approach can change this course and improve the state of maternal care in this country.
Any description of the incredible spectrum of work and advocacy that Miriam has covered in the last decade can hardly be summarized in a sentence or two so I’ll just let her own words describe why we find her to be an inspiring revolutionary.
You first came into the pregnancy and birth world as a doula, what inspired you down this path?
My path started in college with an interest in studying medicine. I was going to be a biology major. I was going to go to medical school. I have always had an interest in women’s health and I thought that becoming a doctor was the path to get there. But then I just happened into a course on the Anthropology of Reproduction and it really just changed my life. It sounds a little bit extreme but I just kind of felt it. I learned about the politics around birth, particularly the medicalization of childbirth in the US. In a way, that topic activated a lot of my passions and gave me something that I really cared about.
I talked with a midwife at my college and she said “if you really want to do this, be a doula first.” I don’t think I had heard about a doula until she told me about it.
How did that work start to shift into advocacy?
I did a summer of volunteer doula work in a hospital in North Carolina. That gave me the experience of supporting people through pregnancy and childbirth but also working with more women with color and seeing the disparity with which these women were treated in the hospital. My parents are immigrants from Cuba. I am a Spanish speaker.
I was able to support women who did not speak English through their birth and saw how differently they were treated by the hospital staff from the white women I also supported.
That also activated a desire to examine who was really suffering the most in the US in terms of the way childbirth happens in this country.
I continued to do volunteer work, particularly with women who were having abortions and miscarriages in New York hospitals. That was another shift as I became more involved in supporting both reproductive autonomy and also new pregnancies, supporting and affirming women with those experiences. For the last five years I have moved on from one-on-one work to more writing and researching and recording issues of maternal health, race and gender more broadly.
How you see the long term vision of your impact, is that what led you to shifting from one-on-one to having more of a wider reach?
Now that I look back and I think about what I wanted to do at the start, it was always about wanting to reach more people and having a bigger impact. I did a lot of work for many years talking to doulas particularly through my website The Radical Doula. I really loved being able to inform and shape their work, particularly around issue of politics and policies and race.
When the opportunity came to do the Ted Talk, I was like, “Well, what do I have to say to a broader audience? What do I think is really important for people to understand outside of our world of birth activists?” Where things continue to be an issue is this real crisis of maternal health and race in the United States. Just how much disparity exists, particularly for black women in this country, and the way that which those experiences and those statistics are just a microcosm of the larger social inequities. Plus, I think something about pregnant women and babies reaches people in a way that other things don’t necessarily do.
There is an opportunity to really shift a whole generation’s health if we can figure out how to improve the way with which people come into the world.
Before the election, you had written about how the ACA was starting to close the gap. Obviously, now we are presented with a whole new situation. How does that change your mission or how you are spreading your message? How have you been wrapping your head around where you go from here?
To be honest, I’m really struggling. The election was a severe moment me. But particularly for my community which is mostly queer folk, mostly people of color, mostly people without access to wealth. I don’t know what is going to happen. It is hard to know what to do when people in the leadership actually don’t care. What do you do with that? How do you work in that context where they are actively trying to disenfranchise and keep people from, what I think are, basic human rights?
I’ve been searching a lot in the four months how to reorient myself. I grew up in the Obama era, professionally, so it has been a really difficult, rude awakening that things are not actually getting better. Things are probably going to get worse. The new version of the Affordable Care Act that was presented would have decimated the healthcare of the poor and the sick. I think we are in a moment of reckoning and a lot of non-profit organizations that I have supported over the years are struggling to figure out how to pivot and really trying to do something differently to kind of hold on to what we can hold on in this time I am taking things one day at a time.
I try to maintain hope. And I do think that there is a desire, definitely among my community to try and figure out how to take care each other in a much more collective fashion. I think our community has gotten a lot stronger because of this.
How can individuals can help push forward change to help solve some of these issues?
I think about the research I did in preparation for the Ted talk — generally, the evidence supporting the fact that microaggressions actually affect people’s health. The things that we almost diminish by calling them “microaggressions” are moments that we have every day where people who are marginalized, particularly people of color, face discrimination in small ways all the time. It accumulates to have an impact on people’s long-term health.
It is not just systemic. You can have an impact on someone’s health and well-being even if you are not intending to. It is the power of individual experiences and interactions, the way in which people can transform how they interact with folks on a daily basis.
Shifting the way in which we treat each other can shift health and well-being.
The simple act of holding someone’s hand when they are having a miscarriage or an abortion procedure or giving birth, it’s not about changing their experience. Just witnessing and affirming it can have a really big impact.
All it takes from me is putting aside my judgment and assumption about what the woman is experiencing. If we can apply in our daily lives, we might actually have more impact than we think because these things add up over time.
Just be kinder to the person at the post office. Take care of the people who work for you. Take care of the people who take care of your kids. All the different ways in which people interact with folks.
What would you like to see changed by the time the girl babies of the world are thinking about families and having babies?
I would love a medical system centered on respect for patients. I do think there are lot of good providers out there but as a system, the respect for health and well-being of patients is not at the center. Particularly when you go into environments that are primarily low income. A medical model focused on well-being instead of disease would mean a huge difference in maternity care because at the moment, pregnancy is considered a disease when it is not actually a disease. It is not a disease state to be pregnant.
What would the medical model that focused on the well-being of pregnant women transform? If you are going to focus on somebody’s well-being, you are going to treat them with respect.
I think low income women, particularly women of color, because of statistics and racism, are already treated like problems, not people who deserve well-being or for whom well-being is possible. But you can’t let the statistics be an inevitability.
Jenny Joseph likes to talk about this. She says, “I actually believe that these women can give birth to healthy full term babies.” There are a lot of providers who assume that, because someone is black, a normal, healthy birth is just not possible
I think that it would be an incredible transformation to change that mindset.
If you can think of a word or phrase when you think of pregnancy or motherhood that really captures that life stage in a woman’s life from your experience, what would it be?
The word that comes to mind is HOPE. If we, as a group, give up on bringing life to the world, we are giving up on hope. Right? Hope that we might be building something that future generations will thrive in.
I think there is something really brave about taking that leap, it is not an easy one and it is a risky one. You’re bringing a life into this world that you can’t really protect in the way that you want to. But it is still really hopeful. I think that is a pretty amazing thing to do.
Our new Revolutionaries Interview Series aims to capture stories of inspiring women pushing the envelope in Women’s Health and Women’s Rights with a focus on pregnancy and motherhood.
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